Lee Kanghoon, Kim Hyeong Ryul, Park Seung-Il, Kim Dong Kwan, Kim Yong-Hee, Choi Se Hoon
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, the Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, the Republic of Korea.
Thorac Cardiovasc Surg. 2018 Aug;66(5):384-389. doi: 10.1055/s-0037-1606828. Epub 2017 Oct 9.
We aimed to assess the feasibility, surgical outcomes, and conduit-related complications of colon interposition in patients with esophageal cancer.
Patients with esophageal cancer who underwent colon interposition for esophageal reconstruction between June 2000 and June 2013 were retrospectively reviewed.
A total of 67 consecutive patients (mean age, 62.2 ± 7.9 years) were enrolled. During this time period, 944 patients underwent esophageal reconstruction using gastric conduit. Twelve patients (17.9%) also received neoadjuvant chemoradiotherapy (nCRT). The median follow-up duration was 44 months (range, 1-168 months); median survival duration was 63 months (range, 1-168 months); and 3- and 5-year overall survival rates were 61.6 and 49.4%, respectively. A total of 43 patients (64.2%) experienced at least 1 postoperative morbidity. According to the Clavien-Dindo grading system, 36 patients (54%) experienced postoperative morbidity of higher than Grade III. Pulmonary complications were most commonly observed complications among the patients (18 patients, 26.9%). Anastomosis site leakage developed in 11 patients (16.4%), and 3 of these patients (6.0%) eventually experienced graft failure. On multivariate analysis, nCRT was determined as a significant risk factor for conduit-related complications (leakage, graft failure, fistula, and stricture).
Colon interposition is associated with relatively high complication rates, whereas nCRT is associated with conduit morbidity.
我们旨在评估食管癌患者行结肠代食管术的可行性、手术效果及与管道相关的并发症。
回顾性分析2000年6月至2013年6月间因食管癌行结肠代食管术重建食管的患者。
共纳入67例连续患者（平均年龄62.2±7.9岁）。在此期间，944例患者使用胃管道进行食管重建。12例患者（17.9%）还接受了新辅助放化疗（nCRT）。中位随访时间为44个月（范围1 - 168个月）；中位生存时间为63个月（范围1 - 168个月）；3年和5年总生存率分别为61.6%和49.4%。共有43例患者（64.2%）至少发生1种术后并发症。根据Clavien-Dindo分级系统，36例患者（54%）发生高于Ⅲ级的术后并发症。肺部并发症是患者中最常见的并发症（18例，26.9%）。11例患者（16.4%）发生吻合口漏，其中3例患者（6.0%）最终发生移植失败。多因素分析显示nCRT是与管道相关并发症（漏、移植失败、瘘和狭窄）的显著危险因素。
结肠代食管术相关并发症发生率相对较高；而nCRT与管道并发症相关联
